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Overweight predisposes to microvascular obstruction: insights from the TATORT-NSTEMI trial

Microvascular obstruction (MVO) is a phenomenon associated with worse outcome after acute myocardial infarction. While some studies suggested a benefit of an increased body mass index (BMI) in terms of MVO occurrence in ST-elevation myocardial infarction (STEMI), there are currently no data availabl...

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Main Authors: Troger, Felix (Author) , Eitel, Ingo (Author) , Saraei, Roza (Author) , Stiermaier, Thomas (Author) , Böhm, Michael (Author) , Lauer, Bernward (Author) , Schulze, P. Christian (Author) , Geisler, Tobias (Author) , Bruch, Leonhard (Author) , Klein, Norbert (Author) , Zeymer, Uwe (Author) , Mayr, Agnes (Author) , Buske, Maria (Author) , Desch, Steffen (Author) , Thiele, Holger (Author) , Feistritzer, Hans-Josef (Author)
Format: Article (Journal)
Language:English
Published: April 2026
In: The international journal of cardiovascular imaging
Year: 2026, Volume: 42, Pages: 639-647
ISSN:1875-8312
DOI:10.1007/s10554-026-03606-y
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1007/s10554-026-03606-y
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Author Notes:Felix Troger, Ingo Eitel, Roza Saraei, Thomas Stiermaier, Michael Böhm, Bernward Lauer, P. Christian Schulze, Tobias Geisler, Leonhard Bruch, Norbert Klein, Uwe Zeymer, Agnes Mayr, Maria Buske, Steffen Desch, Holger Thiele, Hans-Josef Feistritzer
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Summary:Microvascular obstruction (MVO) is a phenomenon associated with worse outcome after acute myocardial infarction. While some studies suggested a benefit of an increased body mass index (BMI) in terms of MVO occurrence in ST-elevation myocardial infarction (STEMI), there are currently no data available on the influence of overweight on the development of MVO in Non-STEMI (NSTEMI). Thus, the aim of this study was to assess the association between MVO and BMI in NSTEMI patients. This study investigated a sub-cohort of the TATORT-NSTEMI trial. Overall, 354 patients were included with a median age of 68 years (25% women). Cardiac magnetic resonance imaging (CMR) was performed within four days after the index event. MVO was defined as hypointense core within the infarcted area in late-enhancement sequences. MVO occurred in 97 patients (27%) and patients with MVO had a significantly higher BMI (28.4 kg/m², interquartile range (IQR) 26.1-31.1 vs. 27.3 kg/m², IQR 24.8-30.3, p = 0.024). Dichotomized at 25.6 kg/m² (Youden-index), patients with a BMI above that threshold showed significantly more often MVO (33% vs. 15%, p < 0.001). In logistic regression analysis, BMI > 25.6 kg/m² was a significant predictor of MVO, independent of traditional cardiovascular risk factors. In the current study, an increased BMI has been associated with MVO after NSTEMI. Further, overweight and especially a BMI above 25.6 kg/m² were independent predictors of MVO in these patients, challenging the so-called “obesity paradox”. Lastly, further research on the connection between body weight and microvascular damage in myocardial infarction is needed.
Item Description:Online veröffentlicht: 19. Januar 2026
Gesehen am 12.02.2026
Physical Description:Online Resource
ISSN:1875-8312
DOI:10.1007/s10554-026-03606-y

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